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Why sex hurts, and what to do about it

You're in the mood and your partner is ready, so you make a beeline to the bed with plans to rock the sheets. But then you feel it—a dull ache, an itchy rash, or a searing out-of-no where jab. When you've always enjoyed sex and suddenly it hurts, it can be confusing and worrisome. "Pain during sex is one of the most common things patients ask about, but most of the time, it's caused by something temporary that can be treated," says Alyssa Dweck, MD, an OB/GYN in Westchester, New York and coauthor of V Is for Vagina ($12; amazon.com). In fact, the American Congress of Obstetricians and Gynecologists says that 75% of women experience painful sex at some point in their lives. Get a handle on what's keeping you sidelined from the sack by reading this checklist of symptoms, then the solution that will get you back in the saddle again.

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The outside of your vagina is crazy-irritated

Possible cause: Personal care products. This isn't the kind of burning love anyone hopes to experience. But if irritation and redness on your outer labia or vulva are keeping you from enjoying the action, blame a bad reaction on a personal care product that made contact with the area—such as soap, body wash, massage oil, or even your toilet paper. "Dyes, perfumes, and other additives in these products can trigger vaginitis, or inflammation of the skin around the vagina," says Dr. Dweck.

Get back in the sack: Speed healing by leaving the area alone for a day or two until the irritation subsides. (Dabbing on a lotion or cream can just make the inflammation worse.) Then, take inventory of the products you use below the belt and swap out items with chemical additives for all-natural ones, Dr. Dweck says.

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It itches or stings down there, and there's discharge

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Possible cause: An infection. Discharge can be a tip-off that an infection is causing the pain. The tricky part: figuring out which infection is putting the brakes on your sex life. If the discharge is white, thick, and super itchy, it's probably a yeast infection, an overgrowth of the yeast that normally colonize the vagina, says Dr. Dweck. Another possibility: bacterial vaginosis, which typically has a grayish, watery discharge and a fishy odor. Then there are STDs such as gonorrhea or chlamydia, which often have zero signs but can cause pelvic pain and a greenish-yellow discharge.

Get back in the sack: Check in with your doctor, advises Dr. Dweck. Though an over-the-counter antifungal cream can cure a yeast infection, it's best to rule out something more serious right away. Your doc will prescribe an antibiotic for whatever ails you.

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Your vagina is clamped shut

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Possible cause: Vaginismus. If penetration has gone from painful to downright impossible because your vagina is shut tight, it may signal a little-known condition called vaginismus, says Raquel Dardik, MD, associate professor of obstetrics and gynecology at NYU Langone Medical Center. Characterized by painful, involuntary contraction of the vaginal muscles, the cause is a mystery, though it may be the result of past trauma, like sexual abuse. "It's like your vagina has put up a 'do not enter' sign," adds Dweck.

Get back in the sack: Ask your doctor specifically about vaginismus—otherwise, she might just blow it off as anxiety or stress. That would be a shame, because vaginismus is real, and it's definitely treatable. "We teach women exercises that help them relax the pelvic floor muscles, which can help a great deal," says Dr. Dardik.

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Your vagina feels like the Sahara

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Possible causes: Stress, drugs, or hormones. Vaginal dryness is one of the most common reasons women say they aren't feeling it during sex. Many things can cause it, such as stress, anxiety, or taking meds like antihistamines, which dry out mucus membranes, says Dr. Dweck. "It can also be the result of the normal drop in estrogen levels after childbirth, during breastfeeding, or as you approach perimenopause and menopause," she says.

Get back in the sack: Get things gliding again by using a silicone-based motion lotion to supplement your natural lubrication until stress lifts or estrogen production cranks back up. If it's perimenopause- or menopause-related, the estrogen dip may be permanent. But dryness doesn't have to be, so ask your doctor about options, like using a prescription vaginal estrogen cream.

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Mid-thrust, you feel pain to the side

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Possible cause: Ovarian cysts. A stabbing pain that can be pretty severe before subsiding could be a sign of an ovarian cyst, which your partner accidentally hit during thrusting. "It's not uncommon to have a fluid-filled cyst on the ovary, and if it's rubbed or touched even with the vagina as a barrier, it can hurt quite a bit," says Dr. Dardik.

Get back in the sack: If you feel this jab mid-deed, you definitely want to let your doctor knowespecially if you're post-menopausal, when cysts can indicate something serious. But for younger women, an ovarian cyst is unlikely to be anything to worry about. "The vast majority of cysts are benign and cyclical, and they tend to disappear on their own," says Dr. Dardik.

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During sex, your partner bumps something inside you

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Possible cause: Fibroids. An ovarian cyst isn't the only thing your partner might accidentally bump up against. A sharp pain felt higher in the vagina could be a sign of a uterine fibroida rubbery, stalk-like benign growth in the uterus. A 2014 study in the Journal of Sexual Medicine found that women with fibroids were three times more likely to experience painful sex than fibroid-free women. "The fibroid is probably jutting against the vagina, and then your partner's penis thrusts against it," says Dr. Dweck. Other signs of fibroids include mid-cycle bleeding, heavier periods, and feeling fullness in your lower abdomen.

Get back in the sack: Sometimes fibroids shrink or disappear on their own, and if they aren't causing complications, doctors tend to leave them alone. But if you are diagnosed with fibroids and the condition is making a dent in your sex life, talk to your doctor about minimally invasive surgical removal.

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Sex in any position makes you wince

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Possible cause: Endometriosis. From a dull ache to serious agony, general pain anywhere in the vagina might be the only clue that you have endometriosis. This condition occurs when endometrial tissue migrates outside the uterus and adheres to nearby body parts, such as your ovaries and fallopian tubes. "The tissue acts like sticky glue on different organs, and that can fix them in place," says Dr. Dardik. "That lack of flexibility can make things hurt during sex."

Get back in the sack: If your doctor diagnoses you with endometriosis, you have options: medication can keep tissue growth under control, limiting pain. And surgical removal of the tissue growths also helps, says Dr. Dardik.

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Deep penetration sometimes hurts like crazy

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Possible cause: A tipped uterus. If you experience pain only when your partner thrusts deep, you might have a tipped uterus, says Dr. Dweck. "Usually the uterus is aligned straight with the rest of your body, but some women are born with one that is tipped backward toward the pelvis, and that increases the odds that it gets jostled during sex," she says. It's a weird body quirk that won't affect your health or pregnancy odds.

Get back in the sack: To prevent any jabs, have your guy not thrust too deeply. Or stick to woman on top, where you control the depth of penetration.

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Your perineum flares up in pain

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Possible cause: Childbirth. The perineum is the area between your vulva and your anus. Sometimes, doctors slice this sensitive, nerve-rich tissue during childbirth to ease the baby out and prevent tearing, a procedure called an episiotomy. Most women who undergo an episiotomy heal up just fine, but some continue to experience pain, even after their OB/GYN has given the all-clear to have sex again, says Dr. Dweck.

Get back in the sack: Check in with your doctor, who may advise that you have the episiotomy surgically repaired.

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Your entire vaginal area feels rubbed raw

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Possible cause: You're going at it too often. You know how you can get an overuse injury by running too much or overdoing it at CrossFit? Consider all-over chafing outside and inside the vagina a sign that you've scored an overuse injury in the sack. This can be the result of too much of a good thing. "Having a lot of vigorous sex in a short period of time can leave you feeling raw and tender," says Dr. Dweck.

Get back in the sack: Ease the rawness by keeping things dry down below and wearing loose clothes. In a day or so, you'll be ready to get back in the saddle again.